Little value for money at the CQC

If, as Oscar Wilde once wrote, a cynic is “a man who knows the price of everything, and the value of nothing,” then the Care Quality Commission is starting to look like the most cynical organisation around.

Late last year, the CQC announced a new contract for the supply of Experts by Experience – or lay inspectors – who assist on its inspections of hospitals, care homes and GPs.

Four months after it came into effect, the contract is in chaos.

Experts are leaving in despair at the unravelling of a role the CQC itself calls “critical to the success of our work” as the regulator of health and social care.

Even the Chief Executive, David Behan, admits his own staff are finding it difficult to do their jobs properly. “The contract isn’t performing at the level we would want it to,” he told the CQC’s most recent board meeting in a remarkable understatement of a debacle that could have been predicted.

Problems started as soon as Remploy, a private company, took over the contract for recruiting and training Experts by Experience in three out of four English regions. (The charities that previously did this work hung on to one area in the centre of the country and by all accounts continue to do it well.)

Experts by Experience are members of the public who join CQC inspections specifically to talk to residents, patients and their families and friends. They assess care through the eyes of the service users and make sure the views of some of society’s most isolated and vulnerable are represented in judgements and reports.

The first inkling of the value Remploy placed on this crucial role came when it refused to honour existing terms and conditions. Instead, it told Experts they could re-apply for their jobs – at half the pay. Not surprisingly, many (myself included) declined.

Those that did sign up have since reported a catalogue of failures that further de-value their work.

The whole point of the Experts is that they have experience in a particular area of health or social care. It might be because of their own needs, or through looking after a family member.

But Remploy, and the proliferating army of sub-contractors drafted in to administer the programme have consistently asked Experts to take part in inspections for which they’re not suited.

“I was booked in March for a hospital inspection in June,” said one Expert, reporting a common problem. “When I finally got details it was for a psychiatric service, for which I have no experience so I declined.” The sub-contractor took no notice. The Expert went on getting emails about the same inspection.

Several Experts report having to work out for themselves which of a long list of upcoming inspections they’re suited to and, from the first three letters of a postcode, how far away they are. Then they “bid” for the work. So much for the CQC’s requirement that Experts be matched to inspections according to experience and skills. What, many of us wonder, does Remploy actually do then?

Communication certainly isn’t the company’s forte. Emails often go unanswered. An Expert’s agreement to join a team for a specific inspection is not passed on to the inspector. An inspection might be cancelled or rescheduled but the assigned Expert isn’t told. Double bookings are almost routine. Inspectors are told there’s nobody available when willing Experts are sitting at home unused.

“Did an inspection today,” an Expert reported last week. “Yet again the inspector had initially been told there was no Expert available, then they had another contact confirming that I was the Expert, and then yet another saying again no one was available.”

Some Experts have been asked to travel absurd distances (despite the CQC explicitly wanting to save money on travel expenses). One was asked to join an inspection 190 miles away. Another was sent a list of possible inspections and replied saying there were three he was suited for. “I told them one was just two miles away (from my home). But I was given one 65 miles away.”

Those are just a few examples from the eight separate dossiers of complaints a group of us current and former Experts have sent the CQC over the past two months. Others have been passing on their individual concerns from the start. So have the CQC’s own inspectors whose meticulous plans for these complex and highly sensitive inspections are frequently thrown into disarray.

“I am sorry there has been some confusion over this,” wrote one inspector to a befuddled Expert. “I received an email last week saying an Expert by Experience was not available, so rearranged my schedule and postponed this inspection. Then yesterday I received your message and another saying a different expert was available! I have now been advised to cancel the request and re-book it.”

Resigning provides no escape from this Kafkaesque scene. One Expert recently told Radio 4’s You and Yours about the frustration and anger that had led her to quit. Three days after the broadcast, Remploy rang to book her for an inspection. Another got no acknowledgement of his resignation. Instead, Remploy sent updated time-sheets on which to record his working hours.

In mid-April, a CQC official told me they’d met senior Remploy staff to inform them that the company was “non-compliant” in almost a dozen areas. These included communication, travel and failing to match Experts to inspections. There were concerns too about recruitment, training, data protection and performance management. Remploy was told to come up with a response. Further, high-level meetings would be held.

But since then, very little has changed.

The CQC says formal contract monitoring meetings take place on a monthly basis “to monitor progress against agreed targets.” But my specific questions about the extent to which those targets are being met, and what happens when they aren’t, went unanswered.

Chief Executive David Behan recently wrote to Experts by Experience apologising for a “difficult” few months. “The experience of transferring to the new contracts for many of you was not a good one,” he said.

Another understatement and one that fails to acknowledge that it wasn’t just the transfer that was difficult. It’s the shambles that Experts and inspectors are still trying to deal with every day that needs sorting out.

As Mr Behan points out in his letter, more money’s been committed in the new contract in order to get even more Experts involved in inspections. He says, “the need to deliver the best value for the public money we spend has never been more important.” With the new contract he goes on, “securing best value” has been achieved.

Really? Best price perhaps. But as any Expert by Experience, inspector or care home resident could tell the CQC, that’s not the same thing as best value at all.

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